RE: working in the ER

["Pufahl, Jo" <JPufahl@smdc.org>]

Our program is trying to place us in the ER when we are not flying. Nurses 
and medics.  How do some of your programs do this?  

Do you take primary assignments? 
No, we do not take primary assignments/patients.  They have tried to assign
us a grouping of rooms, and have been upset when we refuse the assignment.
We will be the "extra pair of hands", the float nurse and/or assist as best
as we can so we can leave quickly when the pager goes off.  We do not get
tied down in CT, US, conscious sedation, or in transporting within the
hospital, as we need to leave quickly.  This sometimes causes some
resentment from ER people.  In these situations, I will usually state that I
will help take care of the other patients in the ER so that one of the ER
staff can be the person tied down in long term patient care.

If so what do you have to do to leave when you have a flight?  
We quickly report to the charge nurse and/or to the er nurse who has that
specific room/patient we may have just done some intervention on.

Who do you report off to?  
See above.

Do you punch in to the ER and then out to your flight program when you have
a flight?
We used to bill the ER for any hours after the first hour.  If less than an
hour, we did not charge the er for our time.  At present, we no longer
charge our time to the ER unless we are filling in for a sick call and spend
a majority of an 8 hour shift in the ER.  We still work as the "float" and
do not take an assignment in those cases.

Do you feel you get to use your skills in the ER or are you just an extra
set of hands?
Our basic nursing skills are well utilized.  Our flight nursing skills are
not used, nor do we have the authority to use the  autonomy/decision making
capabilities we use in the transport environment.  This causes us to "think
and smaller, or think and work  within the box" and this can cause both a
personal conflict (you are used to one way of patient care, now must shift
gears and do another way of patient care) and a conflict with your peers,
nurse practitioners, PA's, ER docs and physician consultants.  We often must
rein ourselves in in order not to step on toes.

Is there animosity between flight people and ER staff when you have to leave
them when they are busy?
There used to be a lot of animosity when our second flight person was the
assigned ER nurse and we left them shorthanded.  After the flight, that same
ER nurse would often stay in the ER (since they had been short) and often
didn't return to the pad and help get the ship cleaned up, restocked and
back in service.  Since we are a dedicated flight team now, the ER staff
seems to not be bothered as in the past when we get called out.

There is animosity at times that we feel from the ER staff.  A big part of
it is the perception that the flight crew sits around and does nothing on
down time, also some personalities seem to aggravate or wave a red bull flag
and stir up the pot occasionally.  But for the most part, it is only a few
people who have problems of that nature and it can be blamed to
personalities who would be upset with something else if this perception were
solved.  As a flight crew, we have had some animosity toward the ER staff
(again, only a certain person or two) when we are called away from our
projects, or gotten up in the night for non-critical functions such as:
routine IV start in an ER patient, discharge at 3 in the morning for one or
two patients, clean and remake some ER cots at 3 in the morning)  as the
on-duty er nurses sit at the desk eating, gossiping or reading a newspaper.)
Particularly if we have had multiple flights during the day, afternoon and
early night.  So it goes both ways.  

Our flight crew have office assignments divided up amongst us - both nurses
and medics - that we work on during our down time.  (We are still available
to the ER if they have a sudden influx of critical patients - and sometimes
we help relieve for lunch/supper breaks - but only after we get our meal
first, as we are here for 24 hours, not 8.)  We do our own
policies/procedures, data bases, statistics, PR/public relation work, safety
programs, educational programs, hospital mass casualty committee work,
scheduling, etc. so we aren't sitting around doing nothing.  These jobs are
set aside for emergent ER patients needing care.

The paramedics - even after 12 years - are not accepted in the ER as an
extra pair of hands unless the ER is extremely desperate.  When that occurs,
their skills, knowledge and expertise are rarely used.  The work like the
nurse aides, which irritates the medics who have many years of experience in
patient care - both critical/non-critical.  Some ER nurses feel that if the
medic works to their skill lever/training/licensure - then the medic could
replace the nurse in the ER, and job security becomes an issue.  We have had
many joint committee meetings over the 12 years to define the particular
skills, functions, etc that the medics could use in the ER, and we have
never had any consensus or working document to help direct the medics in ER
work and that would satisfy the ER nurses and the nurses contract issues.  A
true can of worms.  As a flight department, we have sort of given up on
having anything concrete guidelines to work from.


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